HealthScape Advisors, LLC

ACA playbook: Informing 2017 product and marketing strategies
The latest publication of 2014 risk corridor results demonstrates the economic imbalance in the ACA market with only $362 million in funding and $2.87 billion in expected payouts to issuers. Understanding this imbalance, health plans are actively developing their 2017 product and marketing strategies to improve profitability and find the right product and member mix to be successful in a risk adjusted market.

A risky state of affairs
On June 30th, the Department of Health and Human Services (?HHS?) released a report on risk adjustment transfer payments by company for the 2014 benefit year, as well as key state market-level metrics. In this report, HHS noted that absolute transfer payments as a percent of total premium equated to 10%, 21% and 6% in the individual, catastrophic and small group markets respectively. On September 17th, HHS released an updated version of this report, which included additional detailed results for each state market. Based on this report, we calculated the transfer payments as a percent of total premium for each state market. One limiting factor in HHS? report is that transfer payments were calculated at the issuer level and not necessarily the parent company level. Our analysis corrects for the issuer/parent issue to provide an accurate representation of transfers between parent companies.

2016 HHS risk adjustment model changes: update for final rule
The Department of Health and Human Services (?HHS?) recently published its Final Rule to recalibrate the risk adjustment model for the Commercial ACA population. The Final Rule confirms HHS?s intent to use a three year blended approach in calculating risk weights for the model. In the Proposed Rule (released November 2014), HHS published risk weights calibrated using 2010-2012 data with the option of using more recent data (if available). The Final Rule confirms that 2011-2013 data will be used to calibrate the 2016 risk weights and that the weights will be updated each year with the most recent three years of available data. As HHS indicated in the Proposed Rule, the intent is to better align the risk factors with more recent treatment patterns and cost.

Risky business the sequel: 2014 risk adjustment results
On June 30th, the Department of Health and Human Services (?HHS?) issued health plans in the ACA Individual and Small Group markets their estimated Risk Adjustment transfer payments and Reinsurance receipts for 2014. HHS also released a summary report that provided transfer payments and reinsurance receipts by issuer, state and risk pool with supporting market-level data. HealthScape analyzed the reports, and leveraged our first-hand experience in the market to uncover several key insights.

Presentation: Retiree EGWP growth strategies: Don't get caught flat-footed
The Employee Group Waiver Program (EGWP) is a rapidly growing segment of the Medicare Advantage market and is a strategic opportunity that is often over-looked by health plans.

Recording: Retiree EGWP growth strategies: Don't get caught flat-footed
The Employee Group Waiver Program (EGWP) is a rapidly growing segment of the Medicare Advantage market and is a strategic opportunity that is often over-looked by health plans.

Presentation: Discussion of 2014 Risk Adjustment Results
Presentation displays results from the 2014 Risk Adjustment report and is reviewed in an open discussion via webinar.

Recording: Risk Adjustment: What Happened and What is Next?
The is a recording of the webinar and open discussion among Alliance members sharing experiences and results from the 2014 Risk Adjustment report.

Presentation: Role of Ancillary Benefits in the senior market
Regulatory and business conditions are spurring most health plans to evaluate their market position and transform themselves to capture new revenue streams. As a result, health plans are re-evaluating their current ancillary footprint and establishing new ancillary strategies.

Recording: Role of Ancillary Benefits in the senior market
Regulatory and business conditions are spurring most health plans to evaluate their market position and transform themselves to capture new revenue streams. As a result, health plans are re-evaluating their current ancillary footprint and establishing new ancillary strategies.